This notification is to share with you the contact information for non-contracting hospitals post stabilization care or transfer request. Please click here for more information.

Provider Alert: DEA-X Waiver Training

Dear Providers, The DEA-X Waiver training is an identified and important tool in treating opioid disorder. Community Partners are offering DATA 2000 Waiver trainings across California from September to December 2018. Space is limited and registration will be filled on a first come, first served basis, so please register promptly: https://www.surveymonkey.com/r/WaiverTrainingHSS

Provider Alert: The Centers for Disease Control and Prevention (CDC) Health Update - Recommendations for Managing and Reporting Shigella Infections

Important Notice: Electronic Remittance Advice

Important Notice: Standardized Reason Code Crosswalk

Transition of Members on Dialysis to Davita

Effective September 1, 2015 the Alliance has chosen Davita HealthCare to be the preferred provider for outpatient dialysis services. Please refer to the Provider Frequently Asked Questions for more information.

Important Notice - Prior Authorization Changes

Effective September 1, 2015, about 500 outpatient specialty procedures and surgeries no longer require prior authorization. In addition, the authorizations rules for home health services (including home infusion) have been revised. Only the medical care component, administration of infusion services, and physical rehabilitation services require authorization. The Alliance will no longer require prior authorization for miscellaneous items linked to home health or home infusion. Coming soon there will be one consolidated list showing all procedural codes that will require a prior authorization. In the meantime, please refer to the prior authorization grid for a general list of services that require authorization.

HEALTHsuite - Go Live September 1, 2015

The Alliance will be going live on a new claims payment system on September 1, 2015. This new system called HEALTHsuite includes new functionality such as ICD-10 capabilities and will allow us to provide better support to both our members and our providers. The go live should be seamless to our members however, our providers will see a few changes which are being communicated out by our Provider Relations team. If you are a provider and have questions, you can reach the Provider Relations team at 510-747-4510.

We have been working diligently on the implementation and are very excited that our go live date is almost here!

ICD-10 Assistance

On October 1, 2015, all entities covered by the Health Insurance Portability and Accountability Act (HIPAA) must be able to successfully conduct health care transactions using ICD-10 diagnosis and inpatient procedure codes. The implementation date is proposed by the Centers for Medicare & Medicaid Services (CMS). ICD-9 diagnosis and inpatient procedure codes cannot be used for services provided on or after the implementation date of October 1, 2015. After October 1, 2015, we will not accept ICD-9 coded claims with service dates past October 1, 2015. These claims will be denied and will have to be re-submitted with ICD-10 codes.